肺结核患者咯血责任血管及其相关胸部CT表现的分析

目的分析肺结核患者咯血责任血管及其相关胸部CT表现,以期提高支气管动脉介入栓塞(BAE)的治疗效果。方法收集我院2017年10月至2020年10月在本院行胸部CTA及BAE治疗的94例患者的临床及影像资料。总结肺结核不同胸部CT表现与咯血责任血管之间的关系。结果94例患者经CTA检查共发现187支咯血责任血管,其中支气管动脉(BA)124支,非支气管性体动脉(NBSA)63支(多位于肋间动脉及锁骨下动脉);DSA发现咯血责任血管192支,以DSA为诊断“金标准”,CTA对咯血责任血管的检出率为97.4%;35例(占37.2%)病灶周围可见支气管动脉分支局限性迂曲、扩张,供血支气管动脉平均内径为(2.0±0.7)mm;肺结核伴咯血患者胸部CT发现病灶多位于多肺叶,病灶以弥漫性分布为主,多无胸腔积液,此外伴空洞、钙化、支气管扩张及淋巴结钙化等,均与咯血责任血管来源无明显相关性(P>0.05),病灶性质、胸膜增厚程度及结核病灶与增厚胸膜之间关系与咯血责任血管来源明显相关(P<0.05),其中咯血责任血管来源于BA的肺结核伴咯血患者,病灶病变以增殖、渗出为主,邻近胸膜增厚程度多较轻微或没有增厚且增厚胸膜无或轻度黏连者居多,而咯血责任血管来源于BA合并NBSA的肺结核伴咯血患者肺部病变以纤维化为主,邻近胸膜增厚明显,且肺部病灶与增厚胸膜紧密粘连者居多。结论肺结核伴咯血胸部CT表现与咯血责任血管来源关系紧密,可通过胸部CT表现提示咯血责任血管是否源于NBSA,可帮助提高BAE的治疗效果。

Analysis of responsible vessels of hemoptysis and related chest CT findings in pulmonary tuberculosis patients

Objective To analyze the responsible vessels of hemoptysis in patients with pulmonary tuberculosis and their related chest CT manifestations,and to improve the therapeutic effect of bronchial artery embolization(BAE).Methods Clinical and imaging data of 94 patients who received chest CT angiography(CTA)and BAE treatment in our hospital from October 2017 to October 2020 were collected.The relationship between different chest CT findings of pulmonary tuberculosis and responsible vessels of hemoptysis was analyzed.Results A total of 187 vessels responsible for hemoptysis were found in 94 patients by CTA examination,including 124 bronchial arteries(BA)and 63 non-bronchial systemic arteries(NBSA)(mostly located in intercostal arteries and subclavian arteries).192 vessels responsible for hemoptysis were found by DSA.Taking DSA as the gold standard,the detection rate of CTA for vessels responsible was 97.4%.35 cases(37.2%)showed bronchial artery branches with local tortuosity and dilation around the lesions,and the mean diameter of the supplying bronchial artery was(2.0±0.7)mm.The chest CT images of pulmonary tuberculosis patients with hemoptysis showed that most of the lesions were located in multiple lobes and were distributed diffusely without pleural effusion.In addition,there was no significant correlation between cavity,calcification,bronchiectasis,and lymph node and the source of responsible vessels(P>0.05),while the nature of the lesion,the degree of pleural thickening,and the relationship between the tuberculosis lesion and the thickened pleura were significantly correlated with the origin of the responsible vessels for hemoptysis(P<0.05).Among them,the lesions in patients with responsible blood vessels derived from BA were mainly presented as proliferation and exudation,and the degree of adjacent pleural thickening was mostly slight or no thickening,and there was no or mild adhesion of the thickened pleura in the majority.However,the lesions in patients with pulmonary tuberculosis and hemoptysis whose responsible blood vessels were BA combined with NBSA were mainly characterized by fibrosis,and there was obvious thickening of the adjacent pleura,and the lesions mostly closely adhered to thickened pleura.Conclusion The chest CT manifestations of tuberculosis with hemoptysis are closely related to the origin of the responsible vessels of hemoptysis.Chest CT findings can indicate whether the responsible blood vessels for hemoptysis originate from NBSA,which can help improve the therapeutic effect of BAE.